Health economic evaluation of nation-wide screening programmes for atrial fibrillation in the Netherlands

Abstract Aims Screening for atrial fibrillation (AF) is recommended by the European Society of Cardiology guidelines to prevent strokes. Cost-effectiveness analyses of different screening programmes for AF are difficult to compare because of varying settings and models used. We compared the impact a...

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Published in:European heart journal. Quality of care & clinical outcomes 2023-06, Vol.9 (4), p.408-416
Main Authors: van Hulst, Marinus, Tieleman, Robert G, Zwart, Lennaert A R, Pomp, Marc, Jacobs, Maartje S, Meeder, Joan G, van Ofwegen-Hanekamp, Clara E E, Hollander, Monika, Smits, Paul, Hemels, Martin E W
Format: Article
Language:English
Subjects:
Aged
Atrial Fibrillation - diagnosis
Atrial Fibrillation - epidemiology
Cardiac arrhythmia
Cost analysis
Cost-Benefit Analysis
Humans
Mass Screening - methods
Netherlands - epidemiology
Original
Stroke
Stroke - epidemiology
Stroke - prevention & control
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Summary:Abstract Aims Screening for atrial fibrillation (AF) is recommended by the European Society of Cardiology guidelines to prevent strokes. Cost-effectiveness analyses of different screening programmes for AF are difficult to compare because of varying settings and models used. We compared the impact and cost-effectiveness of various AF screening programmes in the Netherlands. Methods and results The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the ARISTOTLE, RE-LY, and ROCKET AF trials combined with Dutch observational data. Univariate, probabilistic sensitivity, and various scenario analyses were performed. The maximum number of newly detected AF patients in the Netherlands ranged from 4554 to 39 270, depending on the screening strategy used. Adequate treatment with anticoagulation would result in a maximum of >3000 strokes prevented using single-time point AF screening. Compared with no screening, screening 100 000 people provided a gain in QALYs ranging from 984 to 8727 and a mean cost difference ranging from –6650 000€ to 898 000€, depending on the screening strategy used. The probabilistic sensitivity analysis (PSA) demonstrated a 100% likelihood that screening all patients ≥75 years visiting the geriatric outpatient clinic was cost-saving. Four out of six strategies were cost-saving in ≥74% of the PSA simulations. Out of these, opportunistic screening of all patients ≥65 years visiting the GPs office had the highest impact on strokes prevented. Conclusion Most single-time point AF screening strategies are cost-saving and have an important impact on stroke prevention.
ISSN:2058-5225
2058-1742
DOI:10.1093/ehjqcco/qcac042